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急性心肌梗死后室间隔穿孔患者的临床特点分析

Clinical Characteristics of Patients with Ventricular Septal Rupture after Acute Myocardial Infarction
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摘要 目的探讨急性心肌梗死(acute myocardial infarction,AMI)后发生室间隔穿孔(ventricular septal rupture,VSR)患者的临床特点。方法入选2010年12月至2018年12月南京医科大学附属南京医院明确诊断为AMI的患者4221例,其中发生VSR的患者50例(VSR组),按照1∶10匹配原则,随机选取未发生室间隔穿孔(且未发生左心室游离壁破裂)的患者500例作为非VSR组,比较两组患者的临床特点。结果(1)AMI患者中出现VSR的风险为1.18%。(2)与非VSR组相比,VSR组女性患者较多,前壁心肌梗死较多,心功能更差,院内病死率较高,差异有统计学意义(P<0.05)。(3)41例(82.0%)患者VSR发生在AMI起病1周之内,其中12例(24%)24 h内发生VSR;7例(14%)发生于1~2周之间。(4)Logistic回归发现:女性(HR=8.451,95%CI:3.433~20.807,P<0.001)、累及前壁心肌梗死(HR=3.069,95%CI:1.051~8.962,P=0.040)、ST段抬高型心肌梗死(HR=10.412,95%CI:1.057~102.525,P=0.045)、入院前胸痛时间大于37 h(HR=6.953,95%CI:2.778~17.405,P<0.001)和就诊时心率快(大于均值80.88次/min)(HR=3.293,95%CI:1.186~9.142,P=0.022)。结论急性心肌梗死发生VSR的风险约为1.18%,而且通常发生在心肌梗死1周内。VSR的危险因素包括累及前壁的心肌梗死、ST段抬高型心肌梗死、入院前胸痛时间大于37 h和就诊时心率快,而男性是AMI患者VSR的保护因素。 Objectives To investigate the clinical characteristics of patients with ventricular septal rupture(VSR)after acute myocardial infarction(AMI),and to analyze the clinical risk factors.Methods A total of 4221 patients with AMI in Nanjing First Hospital from December 2010 to December 2018 were enrolled.Among them,50 patients developed VSR(as VSR group).Based on the 1∶10 matching principle,500 patients without VSR and left ventricular free wall rupture were selected randomly as the control(as non-VSR group).The clinical baseline characteristics were compared between the two groups.Results(1)The risk of VSR in AMI patients was 1.18%.(2)Compared with non-VSR group,patients in VSR group were with higher percentage of female,higher percentage of anterior myocardial infarction(MI),worse cardiac function,and higher hospital mortality.(3)41(82.0%)patients had VSR within 1 week after AMI,of which 12(24%)had VSR within 24 hours and 7(14%)occurred between 1 and 2 weeks.(4)Logistic regression found that predictors of VSR after AMI were female(HR=8.451,95%CI:3.433-20.807,P<0.001),anterior MI(HR=3.069,95%CI:1.051-8.962,P=0.040),ST-segment elevation myocardial infarction(STEMI)(HR=10.412,95%CI:1.057-102.525,P=0.045),chest pain duration before admission more than 37 hours(HR=6.953,95%CI:2.778-17.405,P<0.001)and fast heart rate(more than mean 80.88 beats/min)(HR=3.293,95%CI:1.186-9.142,P=0.022).Conclusions The risk of VSR in patients with AMI is about 1.18%,and it usually occurs within 1 week after AMI.Risk factors for VSR include anterior MI,STEMI,chest pain duration more than 37 hours before admission,and fast heart rate,while male is protective factor for VSR in patients with AMI.
作者 蔡娟 朱琳琳 CAI Juan;ZHU Lin-lin(Department of Cardiology,Nanjing First Hospital,Nanjing Medical University,Nanjing 210006,China)
出处 《岭南心血管病杂志》 CAS 2023年第5期468-474,共7页 South China Journal of Cardiovascular Diseases
关键词 心肌梗死 室间隔穿孔 手术治疗 myocardial infarction ventricular septal rupture procedural treatment
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